The global health strategy to expand childhood immunizations, largely backed by the Bill & Melinda Gates Foundation, is too focused on new vaccines and neglects the fundamental need to improve basic public health and immunization programs in poor countries.

MSF says it favors expanding access to new vaccines — just not at the expense of basic immunizations.

“Twenty percent of the world’s children aren’t even getting the basic vaccines,” said Kate Elder, MSF vaccine policy adviser. The Gates Foundation is driving much of the global health policy decisions around vaccinations, Elder noted, and “Bill Gates’ priority is new vaccines.” The philanthropy’s influence is distorting the agenda to favor new vaccines over basic improvements, she said.

Daniel Berman, MSF’s deputy director for access, cited a recent initiative to distribute a new $7-per-dose pneumococcal vaccine in DR Congo in the middle of a measles outbreak. Why, Berman asked, are donors and health agencies pushing this new, expensive vaccine in Congo if Congolese children still aren’t getting a 30-cent measles vaccine?

The approach appears aimed more at supporting drug industry desires to promote new products than at finding the most efficient and sustainable means for fighting the diseases of poverty, he said.

The Seattle philanthropy, though contacted in advance of the report’s release, declined to comment or respond today to the MSF criticism – or to the group’s call for a new global strategy with more emphasis on beefing up basic, routine immunizations. The organization sponsored by the foundation to promote the new global strategy, the Decade of Vaccines collaboration, also did not respond.

GAVI is one of the Gates Foundation’s longest running projects in global health, and it is the philanthropy’s single largest recipient of funding over the past 10 years. It is estimated to have saved many millions of children’s lives in poor countries in the past decade.

“MSF and GAVI are trying to do the same thing, which is to prevent as many vaccine-preventable deaths as we can, especially among children under the age of five,” said Rowland.

While it’s true that GAVI has emphasized the introduction of new vaccines, he noted that the initiative also funds basic health system strengthening and believes that the nature of the initiative’s funding (which rewards measurable increases in immunization rates and declines in disease rates) provide governments in poor countries with the incentive to invest in basic public health.

Rowland further said that the Global Vaccine Action Plan does not emphasize new vaccines.

“It provides a roadmap to scale up routine immunization efforts, support accelerated disease control programs and introduce new vaccines and vaccine technologies as they become available,” he said. The stated goal of the plan is to improve immunization coverage overall, Rowland said, so it’s not clear what MSF is targeting there for criticism.

MSF’s Elder and Berman said the strategy is clearly based on continuing the status quo approach — emphasizing new vaccines — rather than shifting to a stronger emphasis on improving basic health services and immunizations. And there is little evidence, both said, that the incentive approach taken by GAVI has led poor governments to invest more in their public health systems.

“Clearly, the emphasis remains on introducing new vaccines,” Berman said.

By issuing this report, he said, MSF hopes to challenge the Gates Foundation, the World Health Organization and others in global health leadership to take a much harder look at what’s really working — and what’s not working — in the effort to prevent child deaths in the developing world.

Here is a similar report by Nature News on MSF’s criticism of the Gates-backed global vaccine strategy.

About Author

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science, medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at]humanosphere.org or follow him on Twitter @tompaulson.

Brings up some very interesting problems of who has what incentives. But the question that isn’t asked here is…what do the beneficiaries want? Where are the thoughts and debates of the people who will be on the recieving end of these programs?

Ashley R.

Instead of a new vaccine versus basic vaccine debate about investment/focus — maybe the right approach is to look at burden of illness for vaccine-preventable diseases in particular country/regional context, and then strategize/prioritize vaccination campaigns accordingly?

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Seattle is the epicenter of a global effort to beat back poverty and illness in the poorest corners of the world. We'd like Humanosphere to be your go-to source for news, conversation and analysis about this effort as it unfolds. Your host is Tom Paulson, a reporter with decades of experience covering science, medicine and global health in the US and beyond.